Carlos Centeno and Eduardo Garralda, members of the ATLANTES research programme of the Institute for Culture and Society (University of Navarra, Spain), presented the Ranking of Palliative Care Development at the 9th World Research Congress of the European Association for Palliative Care held in Dublin in June. It is the result of the collaborative work of Kathrin Woitha, José María Martín Moreno, David Clark and the ATLANTES team. Carlos and Eduardo explain.

Carlos Centeno

Eduardo Garralda

Conscious of the increasing interest in monitoring palliative care development internationally, such as the quality of death index, we thought a ranking would be ideal for comparative purposes, putting countries´ performances in place, and motivating the development of palliative care.

As we had conducted a similar ranking in 2007 for the same European Union countries, we reckoned that a reproduction of the same method for updated data from 2013 could be of great interest, not only to reach a ranking classification but to observe changes over time.

For the purposes of this study, palliative care development is understood as a combination of the existence of services in a country (what they have called “resources”) and the capacity to develop further resources in the future (“vitality”). “Resources” comprise three types of indicators of palliative care services per population (inpatient palliative care units and inpatient hospices [IPCU], hospital support teams [HST] and home care teams [HCT]). “Vitality” indicators took into account the existence of a national association, a directory of services, physician accreditation, attendances at key European conferences and the volume of publications on palliative care development.

For the ranking construction itself, the leading country (by raw score) was then considered as the reference point against which all other countries were measured. Weightings were different and a score of 75% of the weight was given to resources while vitality was given a score of 25%. The total sum of points resulted in the final ranking.

What we found out was that the UK achieved the highest level of development (86% of the maximum possible score), followed by Belgium and The Netherlands (81%), and Sweden (80%). With regard to resources only, Luxembourg, the UK and Belgium were leading whereas in vitality, Germany and the UK got the best results. The Netherlands, Malta and Portugal showed the biggest improvements if compared with 2007, whereas the positions of Spain, France and Greece had deteriorated.

These results could be of particular interest to policymakers, as the ranking shows a country’s performance in palliative care in relation to neighbouring countries. Results also highlight good examples in palliative care development that could provide a benchmark for those needing improvement. And, indirectly, the dissemination of this ranking could tackle a major issue in palliative care development: public and professional awareness.

What was really great about the study was that the ranking method permitted a comparison between countries and that it indeed demonstrated changes if we look at the past. Still, either way, we know we have a big challenge ahead if we want to measure real provision of palliative care in a country, and that will require developing indicators capable of measuring palliative care provision by non-palliative care specialists.